Atrial Shunt Therapy for Heart Failure: An Update-JSCAI Article. Atrial Shunt Therapy for Heart Failure: An Update

JSCAI Article. Atrial Shunt Therapy for Heart Failure: An Update

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Atrial shunt therapies have emerged as a possible treatment option for heart failure patients, particularly those with preserved ejection fraction. These therapies aim to relieve elevated left atrial pressure and improve symptoms, exercise capacity, and quality of life. Two randomized clinical trials have shown a reduction in exercise left atrial pressure with atrial shunt implantation, but no significant difference in outcomes or health status compared to the control group. Further analysis suggests that patients with lower pulmonary vascular resistance and no cardiac rhythm management devices may benefit the most from atrial shunt therapy.<br /><br />Despite these findings, there are still many unanswered questions in the field. The optimal design and approach, the specific heart failure phenotype that will benefit the most, and the long-term safety of shunting from the left atrium to the right heart need further research. Currently, the treatment of heart failure relies on medications and device-based therapies, but there is a need for novel treatments that can improve symptoms and quality of life without adding to the pill burden. Atrial shunt therapies offer a potential solution by reducing left atrial pressure, but more research is needed to determine their efficacy, safety, and ideal patient population. <br /><br />Several clinical trials have been conducted to evaluate the efficacy and safety of atrial shunt therapy, including the REDUCE LAP-HF I and II trials, which demonstrated the feasibility and safety of a transcatheter interatrial shunt device in patients with heart failure with preserved ejection fraction. The V-Wave system, another atrial shunt device, has also shown promise in early clinical trials. However, the response to atrial shunt therapy may vary depending on the subtype of heart failure, and further research is needed to identify the ideal patient population for this therapy.<br /><br />Future clinical trial design should include appropriate patient stratification and a sufficient number of subjects to allow for meaningful analyses. Noninvasive methods to diagnose heart failure with preserved ejection fraction and latent pulmonary vascular disease are also needed to guide patient selection and monitor treatment response. Additionally, regulatory and payer considerations will play a role in determining the acceptance and reimbursement of atrial shunt therapy. Economic analyses will be critical in demonstrating its cost-effectiveness. Overall, atrial shunt therapies hold promise as a treatment option for heart failure, but further research is needed to fully understand their potential benefits and limitations.

Keywords

atrial shunt therapies

heart failure patients

preserved ejection fraction

left atrial pressure

exercise capacity

quality of life

pulmonary vascular resistance

cardiac rhythm management devices

novel treatments

clinical trials